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1996 Milroy MDMA Related Death Study
Comments

Pathology of deaths associated with "ecstasy" and "eve" misuse,
by C.M. Milroy; J.C. Clark; A.R.W. Forrest
Journal of Clinical Pathology Vol 49, 1996; 149-153




From: peter@petermc.demon.co.uk (Peter McDermott)
Date: Tue, 13 Feb 1996 14:19:24 +0000
Newsgroups: alt.drugs,alt.drugs.psychedelic,rec.drugs.misc,rec.drugs.psychedelic
Subject: New data on MDMA risks

Today's Independent gives an interesting account of a new study published in the Journal of Clinical Pathology.

Seven deaths were examined over the last three years, all men between 20 and 25. Three collapsed at a rave or club, two were found in bed, one collapsed in the street and one was admitted to hospital with severe jaundice.

Researchers found that all the dead men's livers showed "dramatic changes" with dead tissue seen in all cases. Similar damage was found in the hearts of five of the men, and swelling, bleeding and damaged nerves were evident in the brains of three. Internal bleeding was found in the lungs in two cases, and damage due to loss of blood supply seen in the lungs of a third.

Apparently, the changes were the same as those present in cases of deaths from heatstroke, but only two of the seven had suffered a sharp rise in body temperature, with readings between 39.5C and 44C.

The forensic pathologist who conducted the study, Dr. Chris Milroy, is quoted as saying "the short term risks of ecstasy use are becoming increasingly more apparent, and questions must be asked about the long-term effects on the brain, liver and heart, considering the pathology in those who die."



From: lamontg@u.washington.xxx (Lamont Granquist)
Date: 15 Feb 1996 01:43:17 GMT
Newsgroups: alt.drugs,alt.drugs.psychedelic,rec.drugs.misc,rec.drugs.psychedelic,sci.med
Subject: Re: New data on MDMA risks

peter@petermc.demon.co.uk (Peter McDermott) writes:
>Researchers found that all the dead men's livers showed
>"dramatic changes" with dead tissue seen in all cases.

consistant with heatstroke in 6 of the cases:

"The pathology of heatstroke has been reported in a number of papers. In the liver the most striking change is centrilobular necrosis. Sinusoidal congestion and dilatation, and portal and sinusoidal inflammation may be present. Fatty change has been reported occasionally. Cholestasis may be present, especially in fatal cases. Rubel and Ishak34 did not find liver necrosis as frequently as other authors. They examined the liver in 50 military recruits who had died of heatstroke. These men were predominantly white. Kew et a131 had found liver necrosis a common finding in black South African gold miners. The difference in frequency may be related to the fact that the gold miners work in very high environmental temperatures with over 90% humidity, con-ditions not dissimilar to some raves and discos.''

and in the other case with jaundice it was consistant with an ideosyncratic reaction to MDMA:

"In the seventh case death was caused by fulminant liver failure and although hyperpyrexia may have been present at some time. In the seventh case death was caused by fulminant liver failure and postmortem examination revealed massive hepatic necrosis. All investigations for the cause of liver failure were negative. The young man admitted to regular and heavy ecstasy use, and this case is similar to cases described by Henry et al.7 There is increasing evidence that "ecstasy" is hepatotoxic, and liver changes have been re-ported following biopsy. 10 55 "These changes, however, differed from those found in the acute deaths described above. Whether the damage is caused by an idiosyncratic reaction to MDMA, or a contaminant of the drug is unclear. Therefore, there seems to be a second mechanism for liver injury from ring substituted amphetamines unrelated to hyperthermia. [...] Individual susceptibility to ring substituted amphetamines may be related to its metabolism in the liver. Abnormalities have been reported in demethylation in susceptible individuals, related to human debrisoquine hydroxylase (CYP2D6).38''

>Similar damage was found in the hearts of five of the men,
>and swelling, bleeding and damaged nerves were evident
>in the brains of three. Internal bleeding was found in
>the lungs in two cases, and damage due to loss of blood
>supply seen in the lungs of a third.

"The brain of one of the cases of rapid death showed disseminated intravascular coagulation (DIC), oedema and degeneration of neurones, particularly apparent in the locus ceruleus. Two cases showed foci of haemorrhage (fig 4). One case showed severe cerebral oedema consistent with water intoxication and had additional occasional perivascular haemorrhages.''

This is acute brain damage as a result of a medical crisis (perhaps not MDMA-induced heatstroke in all cases) and not the result of 5-HT neurotoxicity. Similarly the internal bleeding in the lungs is another symptom of an acute crisis.

The only thing I don't know about is the myocardial damage. They state that it was consistant with catecholamine induced myocardial injury, but i don't know how severe of a risk this is. They also state that:

"[WRT heat stroke] In the myocardium contraction band necrosis and small foci of necrosis with a mixed inflammatory infiltrate are seen. These features are also evident in catecholamine induced injury. In the brain ring haemorrhages and hypoxic changes have been described. The kidneys may show acute tubular necrosis and pulmonary haemorrhage is common.''

>Apparently, the changes were the same as those present in
>cases of deaths from heatstroke, but only two of the seven
>had suffered a sharp rise in body temperature, with readings
>between 39.5C and 44C.

This doesn't really say anything new about MDMA risk-assessment, though. It just means that in the cases of deaths due to MDMA, we may not know exactly what is going on and it may not be as simple as "MDMA-induced heat stroke." Interesting from the point of view of finding out what is going on when people die from MDMA, but not that interesting otherwise...

(Oh, I guess interesting if someone still believed that it took heat + dehydration to produce MDMA DIC+Co., but you convinced me that MDMA could do this in the presence of precautions against overheating and dehydration some time ago...)

>The forensic pathologist who conducted the study, Dr. Chris >Milroy, is quoted as saying "the short term risks of ecstasy >use are becoming increasingly more apparent, and questions >must be asked about the long-term effects on the brain, liver >and heart, considering the pathology in those who die."

The heart, yes that kinda concerns me, and I need to do more research to figure out exactly what the heck they're talking about. I don't think that they've got a whole lot of evidence for any long-term effects on the brain and liver, though.

Some silly-ass net-based "news" service in the UK has published a report claiming that based on this article the kid who is drifting in and out of a coma may have brain damage. Really idiotic to base "possible" brain damage on these findings when I'm certain the kid's doctors have run a CAT scan on him (or something similar) and would know if he was having brain hemmorages or not.